Article excerpt

A worrisome trend became dominant in the mental health professions during the last decade. Biological psychiatry has revealed genetic, neurophysiological and chemical correlates of some mental disorders, thereby raising the hope that, eventually, every form of mental suffering will turn out to be of somatic origin. In time, so this vision goes, laboratory tests will be capable of diagnosing any mental condition just as reliably as they do today with, say, metabolic diseases. Then the appropriate pills, aimed at correcting the precise somatic dysfunction, will do the rest. Psychotherapy, of course, will then become obsolete

The recent disillusionment with Prozac did very little to place these high hopes in a more realistic perspective. On the contrary, things became worse with the current reforms in the health care system in the USA. The briefer the methods of psychiatric evaluation and treatment, the better they are rewarded by the insurance companies. Both developments, the scientific and economic, pose the most serious threat to the research and practice of psychotherapy.

This is why I became excited with this new book by Drs. McKenzie and Wright, a psychiatrist and psychoanalyst respectively, who challenge the biological trend. The authors strongly argue that most neurophysiological changes found to be associated with psychoses are the results rather than causes of these diseases. They then venture to advocate their own theory of the causation of mental disease, which has straightforward bearings on therapy and prevention.

I must confess, however, that the book raised some suspicions in me when I began reading it, and I remained highly ambivalent throughout.

The book's thesis is based on the notion of trauma. PTSD (Post-Traumatic Stress Disorder) constitutes a "paradigmatic disorder" for psychoanalysis, as it lucidly demonstrates how a trauma, which is known to have occurred (war, accident, rape, etc.), causes, after several months or years, a mental disorder. Sigmund Freud took one step further (one too much, is his opponents' view) and concluded that a similar mechanism lies at the basis of many other disorders, although it is often much more subtle. Some distress, he argued, usually in childhood, turns out to be too painful for the person to cope with at that time; hence it is defended against by repression, denial or whatever defense mechanism available to the person or child at that time. Years later, this suffering, with which the person never coped properly, returns with much greater force and takes over the person's mind in the form of neurosis, psychosis or any other disorder.

The main trouble with this explanation, intuitively appealing as it may be, is that it is hard to validate. How can you prove what really happened in someone else's distant past? The recent debate about "false memories" has raised serious charges against therapists for "transplanting" traumatic events into their patient's memories, much to the agony of the parents who are alleged to have abused the patients in childhood. Can any psychodynamic explanation of this kind, offered by psychotherapists, ever compete with the scientific rigor of PET scans and genetic studies available to biological psychiatry?

Yes, assert McKenzie and Wright. They point out a very specific trauma that they believe to be a cause of schizophrenia, manic-depressive illness and paranoia, as well as other diseases. This trauma, it turns out, does not put the blame on the parents, and is, moreover, amenable to the most objective and reliable corroboration! It is a seemingly innocuous event, namely, the birth of a sibling at a time when the patient was still a baby. The authors convincingly argue that the separation from the mother, and the subsequent sudden shift of motherly attention to the newborn, raise in the baby such intense anxiety that it never properly copes with it. …